Creating 277CA EDI Files

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What are 277CA files

The CA stands for Claim Acknowledgment. The 277CA was formerly known as the unsolicited claim status response. This transaction is used to tell the sender of a claim in detail whether the claim was rejected, if there is additional information necessary and maybe even if the claim is already adjudicated. This transaction is unsolicited, meaning that the trading partner did not send a 276 status request to receive this 277CA. This transaction is usually sent by the receiver after a 837 claim file came in and  has been pre-processed.

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277CA in the HIPAA Claim Master

The creation of the 277CA is a feature in the HIPAA Claim Master that has to be licensed and enabled. If you see the menu items for the 277CA disabled, please contact HIPAAsuite's sales department for a quote.

The HIPAA Claim Master allows two mechanism to create the 277CA.

1. When a file is processed and the trading partner is set up to receive the 277CA, then after each claim is parsed from the 837, a 277CA record is created and filled with a standard claim status and status category that is determined in the 277CA setup screen
2. The claims are exported to the database and a separate process enters values in so-called feed back fields with the results of processing or even adjudication. Then triggered by a query a 277CA record can be created for each claim and packaged into a file to be send back to the claim originator.


The second method is much more precise since it returns actual process data while the first process has only a canned message to convey.

These feed-back fields can also be used by the HIPAA Claim Status Responder to return the status of a claim by finding it in the claim tables and then reading the status from the feed-back fields.

The feedback fields are included in the scripts to create the EDI_Claims and EDI_ClaimDetail tables but they are commented out. If you open the screen to create the tables and scroll both scripts down to the bottom you will see the commented out area of claim acknowledgment fields.


The feedback fields in the SQL scripts

To create the fields you have to uncomment those rows and then save the script. Then you can click on the button "Compare Scripts with existing Table' and the fields will be added to your data tables.

Now you still have to select those fields. For that you go into the screen to set up the database connection and fields and again scroll to the bottom of the field lists and check all the fields in the Claim Acknowledgment section.


The feed back fields checked so they are included in the processing.

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Setting up the Auto generated 277CA

The Database menu item has now a sub menu item "277CA Setup".


The menu for the 277CA Setup screen

When we click on it the following screen comes up:


The 277CA Setup screen

Here we set which are the standard messages for claim status after the 837 file has been received.

The default values are:

for the Claim Status Category: A2- Acknowledgment/Acceptance into adjudication system. - The claim/encounter has been accepted into the adjudication system

for the Claim Status: 20-Accepted for processing.

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Setting up trading partner for 277

The creation of the 277CA is usually instigated by the trading partner who sends the 837 claim file. Though the 277CA is not part of the original HIPAA transactions it is eyed very positively as an important part of lowering the costs of healthcare.

In order to set up a trading partner to receive the 277CA we open the trading partner screen and select the tab with 'Options'


The trading partner setup with the option to generate 277CA's

Here we see the option to 'Create a 277CA for 837 claims'. Once the option is checked the 277CA will be generated every time a 837 EDI file from this trading partner is processed and send back according to the settings in the EDI file Exchange Method.

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Creating a 277CA file manually

The HIPAA Claim Master can create 277CA's manually.

For this we go to the File menu and select "Create 277CA"


The menu to create 277CA's manually

We will see the following screen come up


Step 1 in the screen to create 277CA's manually


Step 1 on this form is to choose the source for the 277CA creation.

1. you select an 837 claim file and create a 277CA file from the claims it contains. The status that is assigned comes from default status values that are set in the Setup screen.
2. Database records in the claim tables. The status information comes from the feed-back fields in the database

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